DHD No. 4 discontinuing home health care program

August 30, 2014

District Health Department No. 4 will discontinue its home health care services after several years of losing money on the program.

The program faces threats from numerous directions, and currently is running a deficit of about $10,000 each month, Administrative Health Officer John Bruning said. The department's board of directors recently voted to eliminate the program. Now, he must find a way to wind down the program in a way that ensures people currently being served get the help they need.

"It's a difficult process, that's for sure," he said. "We've been in the program for many, many years. It's very sad to see it go, but it's been difficult for the last four years so we'll have to figure it out."

The department's board of directors voted 6-2 to end the program, board Chairman Tom Mullaney said. It decided the program's financial losses threatened other services the health department offers.

Along with financial troubles, program Director Linda McNeil will retire soon and the district couldn't find a replacement, Mullaney said. Board members realized they likely needed a full-time marketer for the program along with a new director, and ultimately asked Bruning to report on how shutting down the program should be handled. The department serves Alpena, Cheboygan, Montmorency and Presque Isle counties, and most other health departments don't offer the service.

The home health program provides services to the home-bound who have a medical need that requires skilled hands, McNeil said. That includes people who need IVs set or face a high risk of complications or exacerbation. Home care providers also can provide other services like phsyical, occupational or speech therapy. Providers in turn report to the doctor who referred the patient for services, and the agency typically bills Medicare or Medicaid for the care.

McNeil said the program is serving around 46, with the actual figure constantly changing. As of Thursday, they had not been notified about the decision to terminate the program, but she assured they will be and their care will continue for now.

"At this point we're looking at still accepting referrals through September," she said. "We'll be looking to end care somewhere by the end of November, likely. Nothing is solid yet."

When the department ends the program, it will help any clients still receiving home care to transition, McNeil said. The department certifies patients for 60-day episodes of care, and recertifies anyone who still needs anyone who meets insurance guidelines for home health.

Another 56 people are receiving private duty care, a program the department may continue, McNeil said.

The department's home care program was the first to become certified in Northeast Michigan, McNeil said, forming in 1968 when Medicare was just three years old. She's proud of the standard of care its providers have given and the Community Health Accreditation it holds.

While the department will work with its patients to make sure they get the care they need, McNeil said she's concerned some of the people the program serves may struggle to find a provider.

"We tend to get the referrals that nobody else will serve," she said. "We commonly get told, 'Nobody else will take this patient, will you take them?'"

Bruning, McNeil and Mullaney each named a different culprit behind the program's financial woes. McNeil said new rules, regulations and changes to Medicaid reimbursements under the Affordable Care Act have had a negative impact on health care. While nonprofit agencies are taking on more patients, they're getting less funding and have to cut services to break even.

While Bruning also named changes to Medicare as a source of trouble, he said it's not clear how much the program's troubles relate to the Affordable Care Act.

"This has been a problem that has gone on for quite a few years," he said.

Mullaney said the state has consistently failed to live up to an agreement to fund half of district health department costs, paying only a fraction of that instead.

All three agreed the program faced competition from other home health care providers, which cut down on its clientele. The program's 15 full-time and contract workers will likely lose their jobs, McNeil said.

McNeil said she still passionately believes in home health care services, and urged anyone seeking care to do their own research. She suggested asking friends and family, and checking www.medicare.gov/homehealthcompare when looking for an agency.